US5231080A - Method for the treatment of atherosclerosis, thrombosis, and peripheral vessel disease - Google Patents
Method for the treatment of atherosclerosis, thrombosis, and peripheral vessel disease Download PDFInfo
- Publication number
- US5231080A US5231080A US07/678,187 US67818791A US5231080A US 5231080 A US5231080 A US 5231080A US 67818791 A US67818791 A US 67818791A US 5231080 A US5231080 A US 5231080A
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- US
- United States
- Prior art keywords
- carboxylic acid
- carboethoxy
- alanyl
- phenylpropyl
- alkyl
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/55—Protease inhibitors
- A61K38/556—Angiotensin converting enzyme inhibitors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
- A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/47—Quinolines; Isoquinolines
Definitions
- the invention relates to a method for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease by oral or parenteral administration of compounds which inhibit angiotensin converting enzyme.
- compounds which inhibit angiotensin converting enzyme are particularly suitable for this purpose.
- Particularly suitable for this purpose are compounds of the formula I ##STR2## in which
- n 1 or 2
- R hydrogen, an optionally substituted aliphatic radical having 1-8 carbon atoms, an optionally substituted alicyclic radical having 3-9 carbon atoms, an optionally substituted aromatic radical having 6-12 carbon atoms, an optionally substituted araliphatic radical having 7-14 carbon atoms, an optionally substituted alicyclic-aliphatic radical having 7-14 carbon atoms, or a radical OR a or SR a , in which R a represents an optionally substituted aliphatic radical having 1-4 carbon atoms, an optionally substituted aromatic radical having 6-12 carbon atoms, or an optionally substituted heteroaromatic radical having 5-12 ring atoms,
- R 1 denotes hydrogen, an optionally substituted aliphatic radical having 1-6 carbon atoms, an optionally substituted alicyclic radical having 3-9 carbon atoms, an optionally substituted alicyclicaliphatic radical having 4-13 carbon atoms, an optionally substituted aromatic radical having 6-12 carbon atoms, an optionally substituted araliphatic radical having 7-16 carbon atoms, an optionally substituted heteroaromatic radical having 5-12 ring atoms, or the side chain, protected where necessary, of a naturally occurring o-amino acid,
- R 2 and R 3 are identical or different and denote hydrogen, an optionally substituted aliphatic radical having 1-6 carbon atoms, an optionally substituted alicyclic radical having 3-9 carbon atoms, an optionally substituted aromatic radical having 6-12 carbon atoms, or an optionally substituted araliphatic radical having 7-16 carbon atoms, and
- R 4 and R 5 form, together with the atoms carrying them, a heterocyclic, mono-, bi- or tricyclic ring system having 4 to 15 carbon atoms.
- Particularly suitable ring systems of this type are those of the following group:
- Tetrahydroisoquinoline A
- decahydroisoquinoline B
- octahydroindole C
- octahydrocyclopenta[b]pyrrole D
- 2-azaspiro[4.5]decane E
- 2-azaspiro[4.4]nonane F
- n 1 or 2
- R denotes hydrogen, alkyl having 1-8 carbon atoms, alkenyl having 2-6 carbon atoms, cycloalkyl having 3-9 carbon atoms, aryl which has 6-12 carbon atoms and can be mono-, di- or trisubstituted by (C 1 -CH 4 )-alkyl, (C 1 -C 4 )-alkoxy, hydroxyl, halogen, nitro, amino, aminomethyl, (C 1 -C 4 )-alkylamino, di-(C 1 -C 4 )-alkylamino, (C 1 -C 4 )-alkanoylamino, methylenedioxy, carboxyl, cyano and/or sulfamoyl, alkoxy having 1-4 carbon atoms, aryloxy which has 6-12 carbon atoms and can be substituted as described above for aryl, mono- or bicyclic heteroaryloxy which has 5-7 or 8-10 ring atoms respectively, 1 to 2
- R 1 denotes hydrogen, alkyl having 1-6 carbon atoms, alkenyl having 2-6 carbon atoms, alkynyl having 2-6 carbon atoms, cycloalkyl having 3-9 carbon atoms cycloalkenyl having 5-9 carbon atoms, (C 3 -C 9 )-cycloalkyl-(C 1 -C 4 )-alkyl, (C 5 -C 9 )-cycloalkenyl(C 1 -C 4 )-alkyl, optionally partially hydrogenated aryl which has 6-12 carbon atoms and can be substituted as described above for R, (C 6 -C 12 )-aryl-(C 1 -C 4 )-alkyl or (C 7 -C 13 )-aroyl-(C 1 or C 2 )-alkyl, both of which can be substituted as the abovementioned aryl, mono- or bicyclic, optionally partially hydrogenated heteroaryl which has 5-7 or 8-10 ring
- R 2 and R 3 are identical or different and denote hydrogen, alkyl having 1-6 carbon atoms, alkenyl having 2-6 carbon atoms, di-(C 1 -C 4 )-alkylamino-(C 1 -C 4 )-alkyl, (C 1 -C 5 )-alkanoyloxy-(C 1 -C 4 )-alkyl, (C 1 -C 6 )-alkoxycarbonyloxy-(C 1 -C 4 )-alkyl, (C 7 -C 13 )-aroyloxy-(C 1 -C 4 )-alkyl, (C 6 -C 12 )-aryloxycarbonyloxy-(C 1 -C 4 )-alkyl, aryl having 6-12 carbon atoms, (C 6 -C 12 )-aryl-(C 1 -C 4 )-alkyl, (C 3 -C 9 )-cycloalkyl or (C 3 -C 9
- R 4 and R 5 have the abovementioned meaning.
- n 1 or 2
- R denotes (C 1 -C 6 )-alkyl, (C 2 -C 6 )-alkenyl, (C 3 -C 9 )-cycloalkyl, amino-(C 1 -C 4 )-alkyl, (C 2 -C 5 )-acylamino-(C 1 -C 4 )-alkyl, (C 7 -C 13 )-aroylamino-(C 1 -C 4 )-alkyl, (C 1 -C 4 )-alkoxycarbonylamino-(C 1 -C 4 )-alkyl, (C 6 -C 12 ) aryl-(C 1 -C 4 )-alkoxycarbonylamino-(C 1 -C 4 )-alkyl, (C 6 -C 12 )-aryl which can be mono-, di- or trisubstituted by (C 1 -C 4 )-alkyl, (C 1 -C 4 )
- R 1 denotes hydrogen or (C 1 -C 6 )-alkyl which can optionally be substituted by amino, (C 1 -C 6 )-acylamino or benzoylamino, (C 2 -C 6 )-alkenyl, (C 3 -C 9 )-cycloalkyl, (C 5 -C 9 )-cycloalkenyl, (C 3 -C 7 )-cycloalkyl-(C 1 -C 4 )-alkyl, (C 6 -C 12 )-aryl or partially hydrogenated aryl, each of which can be substituted by (C 1 -C 4 )-alkyl, (C 1 or C 2 )-alkoxy or halogen, (C 6 -C 12 )-aryl-(C 1 to C 4 )-alkyl or (C 7 -C 13 )-aroyl-(C 1 -C 2 )-alkyl, both of which can be substituted in the ary
- R 4 and R 5 have the abovementioned meaning.
- n 2
- R denotes phenyl
- R 1 denotes methyl
- R 2 and R 3 denote identical or different (C 1 -C 6 )-alkyl radicals or (C 7 -C 10 )-aralkyl radicals such as benzyl or nitrobenzyl, and
- R 4 and R 5 together represent a radical of the formula ##STR4## in which
- n 0 or 1
- p denotes 0, 1 or 2
- aryl is to be understood preferably to be substituted phenyl, biphenylyl or naphthyl.
- a corresponding statement applies to radicals derived from aryl, such as aryloxy and arylthio.
- Aroyl is particularly understood to be benzoyl.
- Aliphatic radicals can be straight-chain or branched.
- a mono- or bicyclic heterocyclic radical having 5 to 7 or 8 to 10 ring atoms respectively, 1 to 2 of these ring atoms representing sulfur or oxygen atoms and/or 1 to 4 of these ring atoms representing nitrogen atoms is to be understood to be, for example, thienyl, benzo[b]thienyl, furyl, pyranyl, benzofuryl, pyrrolyl, imidazolyl, pyrazolyl, pyridyl, pyrimidinyl, pyridazinyl, indazolyl, isoindolyl, indolyl, purinyl, quinolizinyl, isoquinolinyl, phthalazinyl, naphthyridinyl, quinoxalinyl, quinazolyl, cinnolinyl, pteridinyl, oxazolyl, isoxazolyl, thiazolyl or isothiazolyl.
- R 1 represents a side chain of a protected naturally occurring ⁇ -amino acid such as, for example, protected Ser, Thr, Asp, Asn, Glu, Gln, Arg, Lys, Hyl, Cys, Orn, Cit, Tyr, Trp, His or Hyp
- the preferred protective groups are the groups customary in peptide chemistry (cf. Houben-Weyl, Vols. XV/1 and XV/2).
- the known amino protective groups but in particular Z, Boc or (C 1 -C 6 )-alkanoyl, are preferred.
- Suitable and preferred as O-protective groups for tyrosine are (C 1 -C 6 )-alkyl, in particular methyl or ethyl.
- ACE inhibitors of the formula I can be prepared by reacting together their fragments in a suitable solvent, where appropriate in the presence of a base and/or of a coupling auxiliary, where appropriate reduction of unsaturated compounds which have resulted as intermediates, such as Schiff's bases, and elimination of protective groups which have been introduced temporarily to protect reactive groups and, where appropriate, conversion of the resulting compounds into their physiologically tolerated salts.
- the reaction of these compounds can, for example, be carried out in analogy to known peptide coupling processes in the presence of coupling auxiliaries such as carbodiimides (for example dicyclohexylcarbodiimide), diphenylphosphoryl azide, alkanephosphoric anhydrides, dialkylphosphinic anhydrides or N,N-succinimidyl carbonates in CH 3 CN.
- Amino groups in compounds of the formula V can be activated with tetraethyl diphosphite.
- the compounds of the formula VI can be converted into active esters for example with 1-hydroxybenzotriazole), mixed anhydrides (for example with chloroformic esters), azides or carbodiimide derivatives, and thus be activated (cf. Schroder, Lubke, The Peptides, Vol. 1, New York, 1965, pages 76-136).
- Alkylations of this type are advantageously carried out in water or an organic solvent, in the presence of a base.
- compounds of the formula IX can be condensed with compounds of the formula X ##STR7## in which either Q 1 represents amino+hydrogen and Q 2 represents oxo, or Q 1 represents oxo and Q 2 represents amino+hydrogen.
- the condensation is advantageously carried out in water or an organic solvent such as a lower alcohol, and in the presence of a reducing agent such as NaBH 3 CN, whereupon compounds of the formula I are obtained directly.
- a reducing agent such as NaBH 3 CN
- R-R 5 and n are as defined in formula I.
- Protective groups introduced temporarily to protect reactive groups not involved in the reaction are eliminated after reaction is complete in a manner known per se (cf. Schroder, Lubke, loc. cit., pages 1-75 and 246-270).
- These compounds can be prepared by, for example, the process described in German Patent Application P 3,333,455.2, in which process the tert.-butyl or benzyl esters described in the application are converted into the monocarboxylic acid derivatives in known manner by acid or alkaline hydrolysis or by hydrogenolysis catalyzed by noble metals.
- the N ⁇ -benzyloxycarbonyl protective group of the lysine derivatives is removed by hydrogenolysis catalyzed by noble metals.
- the compounds listed above can be readily converted with physiologically tolerated acids or bases (in the case of mono- or dicarboxylic acids) into the corresponding salts (for example hydrochlorides, maleates, fumarates etc.) and be used as salts according to the invention.
- the compounds of the formula I are inhibitors of angiotensin converting enzyme (ACE) or intermediates in the preparation of such inhibitors, and they can also be used to control high blood pressure of various etiologies.
- ACE angiotensin converting enzyme
- the compounds of the formula I are disclosed in, for example, U.S. Pat. No. 4,129,571, U.S. Pat. No. 4,374,829, European Patent A-79,522, European Patent A-79,022, European Patent A-49,658, European Patent A-51,301, U.S. Pat. No. 4,454,292, U.S. Pat. No. 4,374,847, European Patent A-72,352, U.S. Pat. No. 4,350,704, European Patent A-50,800, European Patent A-46,953, U.S. Pat. No. 4,344,949 European Patent A-84,164, U.S. Pat. No. 4,470,972, European Patent A-65,301 and European Patent A-52,991.
- ACE inhibitors such as, for example, ramipril, enalapril, captopril, lisinopril, perindopril, cilazapril, RHC 3659, CGS 13945, CGS 13928C, CGS 14824A, CI-906, SCH 31846, zofenopril, fosenopril, alacepril and others.
- Orally effective ACE inhibitors are described in, for example, Brunner et al., J. Cardiovasc. Pharmacol. 7 (Suppl. I) (1985) S2-S11.
- Preferred ACE inhibitors are those disclosed in European Patent A-79022, of the formula III ##STR9## in which R denotes hydrogen, methyl, ethyl or benzyl, in particular the compound of the formula III in which R denotes ethyl (ramipril).
- ACE inhibitors are those disclosed in European Patent A-84,164, of the formula IV ##STR10## in which R 4 denotes hydrogen, C 1 -C 4 )-alkyl or benzyl, in particular the compound of the formula IV, in which R 4 denotes ethyl.
- the angiotensin converting enzyme inhibitors described above can be administered to mammals such as monkeys, dogs, cats, rats, humans etc.
- the compounds which are suitable for the use according to the invention are advantageously incorporated in pharmaceutical products in customary manner. They can be converted into the customary administration forms, such as capsules, tablets, coated tablets, solutions, ointments and emulsions, as well as into a depot form.
- the active compound can, where appropriate, also be in microencapsulated form.
- the products can contain additional, tolerated organic or inorganic substances, for example granulating auxiliaries, adhesives and binders, lubricants, suspending agents, solvents, antibacterial agents, wetting agents and preservatives. Forms for oral and parenteral administration are preferred.
- the compounds of the formula I can be administered in dosages of 0.1-50 mg per dose once to three times a day.
- ACE inhibitors in combination with substances which influence prostaglandin metabolism.
- substances which influence prostaglandin metabolism are stable prostacyclin analogs, inhibitors of thromboxane synthetase, and thromboxane antagonists.
- the invention also relates to pharmaceutical compositions containing a) an ACE inhibitor or its physiologically tolerated salt and b) a substance which influences prostaglandin metabolism or its physiologically tolerated salt, and to their use for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease.
- the invention furthermore relates quite generally to products containing the substances mentioned above under a) and b), as combination products for concurrent, separate or sequential administration for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease.
- Blood platelets contain an angiotensin-I-processing system, and their membrane has binding sites with high affinity for angiotensin II.
- ACE angiotensin converting enzyme
- the fact that angiotensin converting enzyme (ACE) is preponderantly located on the luminal cytoplasmic membrane of the endothelial cells points to platelet/endothelium interactions being associated with local angiotensin II production; ACE inhibitors can interfere with this.
- ACE angiotensin converting enzyme
- inhibition of ACE potentiates the action of bradykinin by preventing its breakdown. It is known that bradykinin is a potent stimulator of the release of prostacyclin from endothelial cells; bradykinin is in turn a potent inhibitor of platelet aggregation.
- Platelet-rich rabbit plasma is obtained as stated by Born (Arzneiffen-Forsch. 31, 2012 (1981)). Platelet aggregation is measured by the increase in light passing through a cell which contains this plasma. The platelet count is adjusted to 450,000/mm 3 by dilution with autologous, platelet-poor plasma.
- the compound of the formula II has, in concentrations of 0.1-10 ⁇ g/ml of plasma, no effect on the aggregation induced by 0.24 mmol/l arachidonic acid, 5 mmol/l ADP or 4 pg/ml collagen. In contrast, the inhibition, brought about by 4 ⁇ g/ml PGI 2 , of aggregation caused by arachidonic acid is increased to 100% by the compound of the formula II in the said dose range.
- Conscious rabbits received a single oral dose of 1.0-10.0 mg/kg of the compound of the formula II. After 1 hour, the animals are sacrificed, and platelet-rich plasma is obtained. Platelet aggregation is determined as described under A).
- Conscious rabbits received 1 mg/kg/d of the compound of the formula II for 14 days, and then the procedure was continued as described under 1). Pronounced inhibition of the platelet aggregation induced by arachidonic acid and ADP is found in all animals.
- N-(1-S-carboethoxy-3-phenylpropyl)-S-alanyl-1S,3S,5S-2-azabicyclo[3.3.0]octane-3-carboxylic acid and corn starch are mixed with an aqueous gelatine solution.
- the mixture is dried and milled to granules.
- Microcrystalline cellulose and magnesium stearate are mixed with the granules.
- the resulting granules are compressed to form 1000 tablets, each tablet containing 10 mg of the ACE inhibitor.
- These tablets can be used for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease.
- Gelatine capsules each containing 10 mg of N-(1-S-carboethoxy-3-phenylpropyl)-S-alanyl-1S,3S,5S-2-azabicyclo[3.3.0]octane-3-carboxylic acid are filled with the following mixture:
- These capsules can be used for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease.
- N-(1-S-carboxy-3-phenylpropyl)-S-alanyl-1S,3S,5S-2-azabicyclo[3.3.0]octane-3-carboxylic acid the preservatives and sodium chloride are dissolved in 3 l of water for injections, and the solution is made up to 5 l with water for injections.
- the solution is filtered sterile, and dispensed aseptically into presterilized bottles, which are closed with sterilized rubber caps. Each bottle contains 5 ml of solution.
- Tablets which can be used for the treatment of atherosclerosis, of thrombosis and/or of peripheral vessel disease are prepared as described in Example 1, with the exception that in place of N-(1-S-carboethoxy-3-phenylpropyl)-S-alanyl-1S,3S,5S-2-azabicyclo[3.3.0]-octane-3S-carboxylic acid
- N-(1-S-carboxy-3-cyclohexylpropyl)-S-lysyl-1S,3S,5S-2-azabicyclo[3.3.0]octane-3-carboxylic acid are used.
- N-(1-S-carboxy-3-cyclohexylpropyl)-S-lysyl-1S,3S,5S-2-azabicyclo[3.3.0]octane-3-carboxylic acid are used.
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Abstract
Description
______________________________________ N-(1-S-carboethoxy-3-phenylpropyl)-S-alanyl- 10 g 1S,3S,5S-2-azabicyclo[3.3.0]octane-3- carboxylic acid Corn starch 140 g Gelatine 7.5 g Microcrystalline cellulose 2.5 g Magnesium stearate 2.5 g ______________________________________
______________________________________ N-(1-S-carboethoxy-3-phenylpropyl)-S-alanyl- 10 mg 1S,3S,5S-2-azabicyclo[3.3.0]octane-3- carboxylic acid Magnesium stearate 1 mg Lactose 214 mg ______________________________________
______________________________________ N-(1-S-carboxy-3-phenylpropyl)-S-alanyl- 250 mg 1S,3S,5S-2-azabicyclo[3.3.0]octane-3- carboxylic acid Methylparaben 5 g Propylparaben 1 g Sodium chloride 25 g Water for injections 5 l ______________________________________
Claims (6)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/678,187 US5231080A (en) | 1985-10-15 | 1991-03-29 | Method for the treatment of atherosclerosis, thrombosis, and peripheral vessel disease |
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE3536687 | 1985-10-15 | ||
DE19853536687 DE3536687A1 (en) | 1985-10-15 | 1985-10-15 | METHOD FOR TREATING ATHEROSCLEROSIS, THROMBOSIS AND PERIPHERAL VESSEL DISEASE |
US91743086A | 1986-10-10 | 1986-10-10 | |
US39305889A | 1989-08-11 | 1989-08-11 | |
US07/678,187 US5231080A (en) | 1985-10-15 | 1991-03-29 | Method for the treatment of atherosclerosis, thrombosis, and peripheral vessel disease |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
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US39305889A Continuation | 1985-10-15 | 1989-08-11 |
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US5231080A true US5231080A (en) | 1993-07-27 |
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US07/678,187 Expired - Lifetime US5231080A (en) | 1985-10-15 | 1991-03-29 | Method for the treatment of atherosclerosis, thrombosis, and peripheral vessel disease |
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Cited By (11)
Publication number | Priority date | Publication date | Assignee | Title |
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WO1996041640A1 (en) * | 1995-06-09 | 1996-12-27 | The Regents Of The University Of Michigan | Bradykinin analogs as selective thrombin inhibitors |
US6191144B1 (en) * | 1998-08-17 | 2001-02-20 | Warner-Lambert Company | Method of using angiotensin converting enzyme inhibitor to stimulate angiogenesis |
US6610682B2 (en) | 1996-07-15 | 2003-08-26 | Sankyo Company, Limited | Pharmaceutical compositions and methods for the treatment of arteriosclerosis |
US20050043753A1 (en) * | 1999-10-05 | 2005-02-24 | Omnisonics Medical Technologies, Inc. | Apparatus and method for an ultrasonic medical device to treat peripheral artery disease |
US20050101658A1 (en) * | 1999-08-30 | 2005-05-12 | Aventis Pharma Deutschland Gmbh | Use of inhibitors of the renin-angiotensin system in the prevention of cardiovascular events |
US6982249B1 (en) | 1997-04-23 | 2006-01-03 | The Regents Of The University Of Michigan | Bradykinin analogs as selective inhibitors of cell activation |
US20060134213A1 (en) * | 2004-11-05 | 2006-06-22 | Wilson Edward S | Stabilized ramipril compositions and methods of making |
US20060194868A1 (en) * | 1999-08-27 | 2006-08-31 | Sanofi-Aventis Deutschland Gmbh | Pharmaceutical formulations and use thereof in the prevention of stroke, diabetes and /or congestive heart failure |
EP1998810A2 (en) * | 2006-03-13 | 2008-12-10 | The Johns Hopkins University | Augmentation of endothelial thromboresistance |
US7794414B2 (en) | 2004-02-09 | 2010-09-14 | Emigrant Bank, N.A. | Apparatus and method for an ultrasonic medical device operating in torsional and transverse modes |
US8790359B2 (en) | 1999-10-05 | 2014-07-29 | Cybersonics, Inc. | Medical systems and related methods |
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